Lucas GM et al. (2008) Chronic kidney disease incidence, and progression to end-stage renal disease, in HIV-infected individuals: a tale of two races. J Infect Dis 197: 1548–1557

The risk of developing end-stage renal disease (ESRD) is ∼50 times greater for HIV-infected African Americans than for HIV-infected whites, although little is known about the effect of race on the incidence of chronic kidney disease (CKD) and its progression to ESRD.

Lucas et al. performed a cohort study in 3,332 HIV-infected African Americans and 927 HIV-infected whites who had received primary care at the Johns Hopkins Medical Center in Baltimore, MD, USA, since 1990. After a mean follow-up period of ∼4.5 years, 210 of the 4,185 patients who had no evidence of CKD at enrollment developed the disease. Of the 284 patients who either had pre-existing CKD or developed new-onset CKD, 100 progressed to ESRD; 99 were African Americans and one was white. African Americans were only 1.9 (95% CI 1.2–2.8) times more likely than whites to develop CKD, but had a 17.7 (95% CI 2.5–127) times greater risk of developing ESRD than their white counterparts. These data indicate that the higher incidence of ESRD in HIV-infected African Americans than in HIV-infected whites reflects accelerated disease progression more than a greater incidence of CKD.

Given that the incidence of CKD was 40% lower after 2001 than before 1996, probably as a result of improvements in antiretroviral treatment, and that use of an angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker was associated with a 50% reduction in the risk of developing ESRD, HIV-infected African Americans should be considered for routine CKD screening and for early initiation of highly active antiretroviral therapy.